European Network of Bipolar Research Expert Centre (ENBREC): a network to foster research and promote innovative care Chantal Henry, Ole Andreassen, Angelo Barbato, Jacques Demotes-Mainard, Guy Goodwin, Marion Leboyer, Eduard Vieta, Willem Nolen, Lars Vedel Kessing, Jan Scott, et al. To cite this version: Chantal Henry, Ole Andreassen, Angelo Barbato, Jacques Demotes-Mainard, Guy Goodwin, et al.. European Network of Bipolar Research Expert Centre (ENBREC): a network to foster research and promote innovative care. International Journal of Bipolar Disorders, Springer Open, 2013, 1 (1), pp.2. inserm-00814543 HAL Id: inserm-00814543 https://www.hal.inserm.fr/inserm-00814543 Submitted on 17 Apr 2013 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Henry et al. International Journal of Bipolar Disorders 2013, 1:2 http://www.journalbipolardisorders.com/content/1/1/2 REVIEW Open Access European Network of Bipolar Research Expert Centre (ENBREC): a network to foster research and promote innovative care Chantal Henry1,2,3,4*, Ole A Andreassen5, Angelo Barbato6, Jacques Demotes-Mainard7, Guy Goodwin8, Marion Leboyer1,2,3,4, Eduard Vieta9, Willem A Nolen10, Lars Vedel Kessing11, Jan Scott12, Michael Bauer13 and The ENBREC study group14 Abstract Bipolar disorders rank as one of the most disabling illnesses in working age adults worldwide. Despite this, the quality of care offered to patients with this disorder is suboptimal, largely due to limitations in our understanding of the pathology. Improving this scenario requires the development of a critical mass of expertise and multicentre collaborative projects. Within the framework of the European FP7 programme, we developed a European Network of Bipolar Research Expert Centres (ENBREC) designed specifically to facilitate EU-wide studies. ENBREC provides an integrated support structure facilitating research on disease mechanisms and clinical outcomes across six European countries (France, Germany, Italy, Norway, Spain and the UK). The centres are adopting a standardised clinical assessment that explores multiple aspects of bipolar disorder through a structured evaluation designed to inform clinical decision-making as well as being applicable to research. Reliable, established measures have been prioritised, and instruments have been translated and validated when necessary. An electronic healthcare record and monitoring system (e-ENBREC©) has been developed to collate the data. Protocols to conduct multicentre clinical observational studies and joint studies on cognitive function, biomarkers, genetics, and neuroimaging are in progress; a pilot study has been completed on strategies for routine implementation of psycho-education. The network demonstrates ‘proof of principle’ that expert centres across Europe can collaborate on a wide range of basic science and clinical programmes using shared protocols. This paper is to describe the network and how it aims to improve the quality and effectiveness of research in a neglected priority area. Keywords: Bipolar disorder, Clinical practice, Research networks, Standards of care Review Murray 1998) - findings that are reinforced by the recent Background European study on the burden of mental health (Olesen Bipolar disorders (BD) are characterised by recurrent et al. 2012). manic and depressive episodes that usually commence Despite its high prevalence, BD is often unrecognised or in early adulthood and affect 1% to 4% of the general misdiagnosed leading to inappropriate or delayed treat- population (Merikangas et al. 2007). According to the ments, with significant and devastating health and social World Health Organization study on global burden consequences (Baca-Garcia et al. 2007; Hirschfeld et al. of disease, BD are ranked sixth amongst the most 2003; Scott and Leboyer 2012). Even when the diagnosis is disabling illnesses in working age adults worldwide established, it is clear that the management of BD is a (above schizophrenia which is ranked eighth) (Lopez and major challenge, and surveys confirm that suboptimal treat- ment is a common concern across Europe (Scott et al. 2006). The significant disease burden attributable to BD is * Correspondence: [email protected] amplified by additional, often multiple psychiatric and 1 Université Paris-Est, UMR_S955, UPEC, F-94000, Créteil, France physical comorbidities, and premature mortality (Leboyer 2Inserm, U955, Equipe Psychiatrie Génétique, F-94000, Créteil, France Full list of author information is available at the end of the article and Kupfer 2010). The reduced life expectancy in BD © 2013 Henry et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Henry et al. International Journal of Bipolar Disorders 2013, 1:2 Page 2 of 8 http://www.journalbipolardisorders.com/content/1/1/2 due to medical comorbidity and adverse lifestyles is clinical cohorts that reflect the heterogeneity of the disorder about 10 years for men and 11 for women (Chang et al. and facilitate cross-national epidemiological studies, as well 2011). Furthermore, rates of completed suicide have gen- as providing subgroups with adequate statistical power to erally been estimated to be between 10% and 20% explore pathophysiological and gene-environment interac- (Müller-Oerlinghausen et al. 2002). Even if recent studies tions and to conduct clinical trials. This type of research is are more optimistic, rates in BD exceed unipolar depres- only usually achievable through the development and im- sion and schizophrenia (Bostwick and Pankratz 2000; plementation of shared research protocols across a large Dutta et al. 2007). number of centres (Vieta et al. 2011). Whilst adherence to clinical practice guideline recom- In order to disseminate systematic clinical assessment mendations can improve outcome for patients (Goodwin and high quality treatment protocols and to foster re- et al. 2009; Nivoli et al. 2011a, b), many of the algorithms search to improve the management of BD and to develop for BD patients are derived from efficacy data from a better understanding of the mechanisms underlying randomised controlled clinical trials (RCTs). Such RCTs this complex condition, we have developed a network of usually recruit homogeneous samples of patients who will bipolar expert centre at a European level: European represent only about 20% of the BD population treated in Network of Bipolar Research Expert Centre (ENBREC, day-to-day clinical practice (Vieta and Cruz 2012). Also, www.enbrec.eu). This network was set up via FP7 guidelines are not consistent in their recommendations, funding but is maintained through the support from differing in their advice on when to use adjunctive psycho- the European College of Neuropsychopharmacology logical therapies or which type of therapy to offer to differ- (ECNP) network initiative (ECNP-NI). In this paper, we de- ent patient subpopulations (Henry et al. 2011). As a scribe the development of the ENBREC network and the consequence, clinicians often find it difficult to sys- common, cross-national clinical and research tools we tematically apply recommendations to individual cases. For are introducing. example, many guidelines suggest monotherapy as main- tenance treatment (based on findings from RCTs); the clin- Results and discussion ical reality is that many patients receive polypharmacy In 2009, the European Union resolution on Mental Health for mood stabilisation (Frye et al. 2000; Wolfsperger (EU parliament A6-0034-2009) highlighted the need to de- et al. 2007). Other strategies, extending beyond the use of velop comprehensive and integrated mental health strat- guidelines, therefore need to be examined, especially be- egies in Europe, such as cohort studies. As we live in a cause the evidence suggests that efforts made to spread globally competitive environment, it is fundamental for good clinical practice invariably result in gains for pa- Europe's success that high level research is viewed as a pri- tients. For example, Bauer et al. (2009) have shown that ority. This will demand joint responses from member states promoting systematic assessments and offering local sup- and between-country collaborations so that expertise and port to clinicians working with BD improve patient out- experience can be shared, and benefits can be rapidly dis- comes. Similar national initiatives are being undertaken, seminated on a Europe-wide basis. The EU resolution also e.g. the French BD network developed by Fondation acknowledges that the only way to diminish the cost and FondaMental (Henry et al. 2011) and the CIBERSAM burden of mental disorders in the long-term is to invest re- in Spain (Vieta 2011). However, to date, there have been sources in research to improve early diagnosis, develop in- few attempts to facilitate an international programme on novative treatments, and to attempt